It is an ugly and dispiriting time on TV and radio. Even the Christmas music seems dumber, tuned toward the vapid perkiness most conducive to buying more stuff. Over-armed angry men everywhere makes you wonder if Santa is packing.
The way to live in these times is not to be more angry and loud, but do something better.
Look away from the TV. Indeed, look in the exact opposite of a TV or any kind of screen to find hope. Look for a committee of grown-ups trying to do something good, noble and bold. They are everywhere, far more numerous than the mean-spirited nutters. My father, a life-long Methodist, said that you can tell what a person believes by what committees they show up at; not agree to be named to, mind you, but actually show up at. Roy was a member of every necessary committee in every church he and mom ever attended. He believed in church committees more, I think, than he believed in God.
I too, go to church a lot, and thus have abundant experience with their committees, which Brooks Hays of Arkansas once defined as the “unqualified led by the uninspired to do the unnecessary.” Watching committees work is not like watching sausage being made, which at least results in sausage. But humans do not survive alone for long. The only reason we beat out the apes is that we learned to talk in small groups. That’s a committee.
One of my favorite committees these days is the one led by Dr. Soma Stout, a gentle pediatrician from India, but practicing in Boston. She is, with humble mastery of the art of “committeeness,” nurturing the 100 Million Lives Campaign. This is a committee drawn together partly because of the trustworthiness that emanates from Soma and partly because she is flying under the flag of the Institute for Healthcare Improvement (IHI) (Here for the campaign documents.) It is a committee for the ages, an impossibly diverse group of healthcare, hospital, public health, government, academic, patient advocates and a few community organizers and policy wonks.
The 100 Million lLives Campaign is a critical mass of credible partners. Nobody involved has spare time on their (our) hands, and everyone is part of other good and ambitious coalitions. But in these mean times, we are tantalized by how practical–doable—it should be to radically advance the pace of positive change that science and people of hope should be capable of doing. What grown-up can explain refusing to be on that committee?
100 Million of anything is a big number. But we live in a big world. Seventy million people say they go the church at least once a month, so we should be able to bump up their health simply by getting them to do things they’ve already committed to. They are within caring range of another 70 million of their neighbors. Even without worship, In the United States alone there are 100 million “worried well” whose health would improve by stopping thinking about their own health obsessively and pay attention to somebody else.If we think of the rest of the world (a good idea), the proper number is probably 1 or two billion. So while 100 million sounds vast, is well within the range of “ok, I’ll do it.”
IHI is known for its analytic systems and meticulous process improvement techniques in the world of hospitals. Dr. Don Berwick and a team of brilliant colleagues began shaking that world with the 100,000 lives campaign, focused on getting hospitals CEO’s to commit to a simple package of initiatives to eliminate one of the leading causes of deaths in the United States—hospital mistakes. Improving hospital quality is a lot more like chipping rocks in a quarry than writing poetry, but IHI work with technocrats and wonks that the root word for work is, poesis—good labor that heals and builds the world. That is what a grown-up hopes to do when we grow up.
Which brings us to the hard part of the 100 Million Lives Campaign. There are roughly 6 billion of us these days, so which 100 Million? Exactly? Improved how much? By who? Doing what? When? How we will manage it all?! Thich Nhat Hanh/’, the Buddhist monk much smarter than a hospital wonk, said of the art of living that we make our path by walking. This is true of anything any group of humans have ever done worth doing..
That path begins with a moral itch prompted by observing the obvious: given our advanced science, wealth and vast networks of organizations, hundreds of millions of people should be living lives of greater health and well-being than is true. This is obvious because because it is already happening, just not fast or fairly as should be true. In an earlier blog I wrote about the insight of Christoph Benn brought that if we can continue to current global trends for another twenty years we will see a worldwide “grand convergence” in which for the first time in the history of the species there will be rough parity between rich and poor countries (May 11, 2014). When I say rough, I mean rough; there will remain differences between rich and poor, always acerbated by race or ethnicity, in every small town. But differences in life expectancy between countries, for instance, will be gone. We didn’t notice this astonishing reality until the past few years, so fixated we are on the horrible and scary things that rivet our attention. When we look aways from the TV, we might notice that we can achieve profound positive changes in human circumstances…..if……a)we want to and b) we try to and c) we form committees to figure it out.
That’s what the 100 Million Lives Campaign is about ( a “campaign” is just a really big committee). Committees, especially noble ones composed of brilliant highly educated technically proficient people never move in straight logical steps, even when they spend enormous time arguing about which straight logical steps to take. The more educated the committee, the more time they spend this way (This is why faculty committees are the worst of all.)
At their best, committees follow Seth Glier’s counsel to “do the next right thing and the next thing right.” And they keep their eye on the prize, encourage each other to remember with Sam Cooke that “change is gonna come,” and they hold steady until they overcome. The civil rights movement was nothing but lots of committees that walked a lot.
When fully alive a committee becomes a campaign which becomes a movement. This happens when it is moved by a spirit that is beneath, and before, and not entirely of its members. A movement has its members; the members don’t have the movement.
Religious traditions and religious denominations are frozen movements, their language, rituals and orthodoxies so powerful that their followers want to protect them from change, putting them in buildings under glass out of the air. Jerry Winslow, the chair of the Stakeholder Health Advisory Council , says the art of giving structure to change is protecting a movement from degrading into a monument. Their committees may not notice, but everyone around them will.
Humans live in and through complex systems. And every one of us is, “wonderfully and complexly made.” (Psalm 139) Medical people tend to describe people as complex when we find them inconvenient. But the wisest are humble before the wonder of one full human that we love. Dr. Don Berwick, in his keynote speech at the IHI Forum spoke with mesmerizing humility and wonder about what his grandson Caleb was teaching him about health and well-being. (I personally think that my grandson, Charles Isaac, is more handsome, especially in the eyes. But I can see where Don might have an argument.)
Don, the global master who has saved hundreds of thousands of lives because of his technical skills, is learning now about kindness, gentleness, “salutogenesis”, mindfulness, joy and the power of hope in the lives of patients. How much more so in the lives of organizations and movements. He says the quality movement is only halfway there and the next 25 years will be about whole human health—almost unknown and unmapped territory for medical professionals of every flavor. This, of course, is the map being sketched by the Fellows of the Leading Causes of Life Initiative, led by Dr. Jim Cochrane.
Don, Jim, Soma and Christoph know the time is urgent, but right and possible. This year, this month, this week, let your children see you living like a grown up who knows the things that lead toward life. Don’t tell them; show them. Go join a committee and do the obvious next right thing.